SUSTAINED RECOVERY IS POSSIBLE

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KNOW YOUR WHOLE BODY

If someone wishes for good health, one must first ask oneself if he is ready to do away with the reasons for his illness. Only then is it possible to help him.

- Hippocrates

CLINIC FOR RECOVERY (C4R)

C4R is designed for busy people who are seeking sustained, long-term recovery and offers: 

  • Medical services 

  • Medications for recovery (medication-assisted treatment (MAT) )​ 

  • Primary care that is addiction-informed 

  • Select outpatient detox 

  • Therapy Services 

  • Group sessions (recommended weekly to monthly)​ 

  • Individual sessions (as indicated) 

  • Access to psychiatry 

  • Access to recovery-focused nutrition 

  • Access to trauma-sensitive yoga and meditation 

Our C4R model is designed to provide comprehensive outpatient addiction assessment and treatment that blends medical, psychiatric, and therapy-based practices under the same roof. Our multi-disciplinary providers know how important it is to collaborate as a team, which includes the individual client, to best support sustained recovery. We provide a reliable resource for health and wellness that honors both the body and brain, while understanding and treating for the complexities of addiction and trauma. 

  • We utilize evidence-based practices in conjunction with holistic approaches to optimally asses an individual's needs and safely assist with recovery 

  • Our goal is to assess for and prescribe effective medication with as minimal dosing as possible to optimize daily function 

  • Each client is an active participant in the evolution of their medical and therapy treatment goals 

  • We integrate the Five Pillars© of health and wellness to both assist with successful sobriety and sustain long-term recovery 

 

C4R is an ASAM 1.0 level of care 

Why Medication Assisted Recovery (MAR)?   

 

Medication assisted recovery (also known as MAT – or medication assisted Treatment) programs recognize that addiction is a serious disease that affects the mind, body, emotions, and spirit. Addiction recovery treatment is best accomplished when all four of these intrapersonal functional domains are practiced. In this framework, medication is one tool for sustained recovery and is typically not considered a stand-alone treatment.  

 

Medications such a buprenorphine (Suboxone, Subutex, etc.) or naltrexone (Vivitrol) do provide a barrier to relapse, However, these do not address the underlying and initial conditions that lead to the disease of addiction.  

 

Combining MAR with targeted therapy and/or community support is essential for sustained sobriety. These interventions provide ongoing opportunity to strengthen connection with others who also understand the struggles associated with addiction. And, these are also associated with higher potential to reduce or taper-off MAR-based medications.    

 

 

Starting Medication 

We start medication in this clinic under direct observation in order to use the optimum level of medication as well as to reduce any side effects that may result.  It is our experience that the best practice for initiating MAR is in a clinic setting, as opposed to home administration. Direct observation reduces the risk for relapse and/or adverse medication events.   

 

Individual medication programs will be prescribed in a manner that best serves the health of our clients.  the individual, but we will briefly outline some of the medications and classes of medications we use including potential risks and benefits.

  

Through C4R, our internist provides thorough medical examinations in addition to medication management. We recognize the importance to address the physiological (physical) impact that addiction can toll. Identifying and intervening in a timely manner can prevent progression and often times reverse or repair current damage. The examination also include screening for psychiatric illness. 

  • Induction and maintenance treatment for opiate addiction and alcohol addiction related cravings: 

  • ​Opiate-replacement (buprenorphine products: Suboxone, Zubsolv, etc.)​ 

  • Opiate-blocking (naltrexone, Vivitrol) 

  • Other targeted medications and supplements: 

  • Craving reduction​ 

  • Optimizing health and recovery 

  • These medications are not kept on site 

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Through the C4R program, our seasoned addiction-recovery therapists provide individual, group, and couples' sessions. Each therapist is trauma-informed, addiction-informed, and resiliency-focused. Topics that are cornerstones include: 

  • Emotional content that feels unresolved, stuck, or hidden can drive relapse and prevent long-term recovery 

  • Addressing underlying beliefs and unresolved conflicts is essential for sustained recovery 

  • Developing emotional awareness and regulation skills are necessary for effective relationships with self and others, and for sustained recovery 

  • Art therapy can be very effective for starting sobriety and continuous recovery 

  • Through the creative process, we can often identify, understand, and resolve difficult to understand emotional pain​ 

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Medical Outpatient Detox: when and where appropriate, we may be able to offer medical outpatient detox for chemical dependency in the privacy of you own home (or designated safe setting) in combination with daytime hours at Sovegna. This detox option may be appropriate for clients who prefer avoiding an inpatient admission to a hospital or detox facility for personal or public reasons. 

  • This requires medical clearance by our internist (with detailed exam and laboratory studies) 

  • A designated sober confidante is needed who is committed to being part of your at-home detox team 

  • Typical duration: 3-5 consecutive days 

  • Dependence on an addictive substance that may qualify for outpatient detox includes: 

  • Alcohol​ 

  • Benzodiazepines and barbiturates (types of anti-anxiety medications) 

  • Hypnotics (a type of sleep medication) 

  • Opioids and opiates (heroin, opium, kratom, pain pills) 

INJECTABLE NALTREXONE

For patients with any addiction, including Alcohol Use Disorder, Opiate Use Disorder, Stimulant Use Disorder (including cocaine and methamphetamine), blocking the opiate receptors in the brain has been demonstrated to greatly reduce relapse and death when done in a supervised fashion, and in conjunction with the appropriate therapy.

Prior to using Vivitrol (injectable naltrexone), we will require that all patients abstain from any opiates for a minimum of 7 days (in some cases longer) in order to avoid precipitated withdrawal.

Benefits:

  • Blocks opiates' effects from reaching the opiate receptors

  • Reduces cravings for opiates, alcohol, and reduces relapse from alcohol, opiates, methamphetamines, cocaine, and process addictions (sex, gambling, food)

  • Some overall improvements in mood

Risks:

  • For patients with OUD, when first taking this medication there is a risk of precipitated withdrawal, which is extremely uncomfortable and medically stressful. We will minimize the risk by first waiting the recommended period of time and giving smaller trial doses of the medication by mouth for a week prior to the injection

  • Allergic reactions are rare; again, we will minimize this risk by giving oral medications first in small doses to see if there is an adverse reaction. The worst reported symptom is allergy-induced pneumonia.

  • Rarely, patients have a reaction leading to elevated liver enzymes. Regular monitoring will reduce the risk of liver problems.

  • In case of an emergency or surgery, Naltrexone blocks the effects of opiates for pain

BUPRENORPHINE PRODUCTS (ZUBSOLV)

For patients with Opiate Use Disorder (OUD), one option is taking medications containing Buprenorphine combined with naloxone. This medication is a partial agonist: it stimulates one opiate receptor while blocking another, and also has a plateau effect; meaning, after a certain amount of mediation there is no further stimulus from the drug on that day.

This medication greatly reduces the risk of relapse and death for those with OUD who have failed abstinence based therapy, or who are not yet ready to try it. Used alone, it reduces the risk of relapse from 90% to 60%. In combination with appropriate therapy, the risk of relapse at one year is reduced to 40%. In combination with intensive therapy and community support, relapse is reported to be from 30% to 20% at one year.

For those reasons, we require all those in this portion of the MAR program to be involved in a minimum of weekly therapy and some form of community support (12 step (AA, NA, MA, CA), SMART recovery, Lifering, etc).

Benefits:

  • Reduces the risk of death by 20% over one year

  • Provides psychological stability that enables patients to enter and engage in therapy

  • Reduced Hyperalgesia

Risks:

  • If previously taking very high doses of opiates, patients may experience some withdrawal symptoms (mostly irritability, insomnia, sweats, and muscle aches) in the first few weeks of use

  • Similar risks to chronic opiate use (hyperalgesia - increased pain sensitivity, chronic constipation, risk of gallstones, and risk of a hypoactive gallbladder)

  • For male patients, there is a risk of low testosterone and impotence (reversible)

  • In order to stop use, we will still need to taper off, which will cause discomfort

  • If taken with illicit medications or benzodiazepines, a risk of respiratory depression (not breathing enough), and death

  • Swallowing the tablet can cause withdrawal symptoms due to the naloxone

  • There are reports of elevated liver enzymes associated with the medication, although it has not been reported to cause liver failure itself

  • If taken with alcohol, it can result in death

  • Injection site reactions may include: swelling or pain at site of injection, infection at the site of the injection

  • If you require surgery or emergent care, opiates may block you from helping with pain

If you enter into this part of the program, you will agree to abstain from alcohol. Alcohol, when combined with any opiate, can lead to decreased breathing frequency, permanent disability and/or death. If you are also abusing alcohol prior to entering treatment, please let us know so we can design an appropriate program for you.

Patients who elect to use buprenorphine products as part of their treatment program will have to taper off benzodiazepines. This can be done as an inpatient, in our patient detoxification center, or slowly over 1-4 months as an outpatient.

All patients prescribed buprenorphine products will be responsible for the medication's safety in their home. You may need to purchase a medication safe and, at the very least, need to keep these medications away from the reach of small children.

Diversion of medications (selling prescriptions or purchased medications) from this clinic will result in discharge from the clinic immediately. If you are unable to afford medication, rather than sell medication to obtain it, please talk to us about patient assistance programs. See our diversion policy below.

In early recovery, you may have many of the symptoms of withdrawal at lower levels; it is important that you communicate with us about what problems you are having and how they effect you. We want you to succeed, and we are here to support you in your transition to recovery.